Human deaths from drug overdoses with carfentanyl involvement—new rising problem in forensic medicine

Abstract

Carfentanyl, an ultra-potent synthetic opioid, is approved for use only in veterinary medicine as a tranquilizing agent. However, many cases of human poisoning with carfentanyl have recently appeared in the news with limited information given and scientific literature provides only 1 case of documented human exposure to carfentanyl.Fifteen cases of death from drug overdoses with carfentanyl involvement are being presented. Fifteen blood and urine samples have been taken for alcohol and drug testing. Headspace gas chromatography was used for alcohol detection. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) and liquid chromatography–time-of-flight mass spectrometry (LC/MS TOF) system was used for drug detection.Sixty-three cases of death from poisoning with drugs have been tested for carfentanyl in the State Forensic Medicine Service. Fifteen of them were positive for carfentanyl.The cases mentioned above show that carfentanyl exposure causes signs and symptoms similar to other opioid toxicity. Carfentanyl intoxication may even be fatal if appropriate treatment is not available. Therefore, nowadays it is very important to draw forensic medicine expert's attention to new substances in drug trade.

Evidence for nonlinear accumulation of the ultrapotent fentanyl analog, carfentanil, after systemic administration to male rats

“…Here, we validated a UHPLC-MS/MS method that allows for quantitation of carfentanil and norcarfentanil in small-volume rat plasma samples, even after a low dose of 1 μg/kg carfentanil. The method displays a LOQ of 15 pg/mL for carfentanil and norcarfentanil, which is comparable or superior to other methods reported in the literature (Bergh et al, 2018;Cannaert et al, 2018;Elliott and Hernandez Lopez, 2018;Fomin et al, 2018;Hikin et al, 2018;Shanks and Behonick, 2017;Shoff et al, 2017;Swanson et al, 2017;Tiscione and Alford, 2018). Additionally, our method is characterized by acceptable precision and accuracy, coupled with minimal matrix interference.…”

“…Thus, analytical methods for accurate detection of carfentanil require limits of quantification (LOQ) of 10-50 pg/mL (Shanks and Behonick, 2017). Recently, a number of sensitive analytical methods for the detection of carfentanil have been developed (Bergh et al, 2018;Cannaert et al, 2018;Hikin et al, 2018;Shanks and Behonick, 2017;Tiscione and Alford, 2018), but many forensic laboratories lack such methods and may fail to detect carfentanil in postmortem human samples (Elliott and Hernandez Lopez, 2018;Fomin et al, 2018;Shoff et al, 2017;Sofalvi et al, 2017;Swanson et al, 2017).…”

Epidemiological and geospatial profile of the prescription opioid crisis in Ohio, United States

“…Moreover, we identified an increasing trend in mortality rate over time, growing from 10.34 cases per 100,000 inhabitants in 2013 to 16.90 in 2014. The second significant increase trend in opioid related mortality rate was found during July 2015, potentially associated with the introduction of carfentanyl, which is an ultra-potent fentanyl analog known to be approved only for veterinary use 29,30 . The highest increase in mortality rates took place during this period, from 26.10 cases per 100,000 inhabitants in 2015 to 42.33 in 2016.…”

Interpol review of toxicology 2016–2019

“… Subject Age/Sex, [Ref] Case Nature Carfentanil conc. in blood (ng/mL) Other findings 40/M [ 221 ] Death 3.3 1 6-AM∗, methadone, cannabinoids∗, cocaine∗ (COC), olanzapine, tramadol, mirtazapine, diazepam, paracetamol (PAR) 36/M [ 221 ] Death 0.80 1 6-AM∗, methadone, COC∗, 7-aminonitrazepam, 7-aminoclonazepam, trazodone, nortripytline, diazepam, ibuprofen, cannabinoids, clozapine 36/M [ 221 ] Death 0.22 1 6-AM∗, cannabinoids, clozapine 44/F [ 221 ] Death 0.82 1 6-AM∗, dihydrocodine, COC, mebeverine, diazepam, 29/M [ 221 ] Death 0.24 1 6-AM∗, ketamine∗, amphetamine, alprazolam 37/M [ 221 ] Death 0.50 1 1.05 2 0.57 3 Noscapine, cannabinoids, PAR, sertraline 31/F [ 221 ] Death 0.66 1 Morphine∗ (MOR), methadone, COC, amitriptyline 21/M [ 226 ] Suicidal 92 norcarfentanil in blood at 0.532 ng/mL 44/- [ 227 ] Drug overdose 5.1 EtOH, MOR, diphenhydramine (Diphen), methadone 35/- [ 227 ...…”